Provider Demographics
NPI:1396570354
Name:JACKSON, JANELL MONIQUE
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:MONIQUE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 SHIPPEN LN SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2902
Mailing Address - Country:US
Mailing Address - Phone:202-286-0011
Mailing Address - Fax:
Practice Address - Street 1:1415 SHIPPEN LN SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2902
Practice Address - Country:US
Practice Address - Phone:202-520-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health